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John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest blog post by Heather Haugen, PhD, Managing Director and CEO at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Healthcare leaders and clinicians continue to be disappointed with the value Electronic Health Record (EHR) technology provides in their organizations today. The challenges are real, and it will take some time and effort to improve. The technology will continue to evolve at the pace we set as leaders, vendors and healthcare professionals.

When Free Is Expensive
Several years ago, a reputable IT vendor offered us free use of their software, which provided monitoring of equipment that would be valuable to us. Initially, we were excited; the functionality perfectly aligned with our needs, and the application was robust enough to grow with us. We had a need and the software fulfilled the need. We couldn’t wait to have access to the dashboard of data promised by the vendor.

Months after the implementation, we were still waiting. The “free” price tag was alluring, but we quickly recognized the actual maintenance costs and labor required to make the application truly valuable to our organization were far from free. This story drives home a concept that we all understand, but often overlook. Underestimating the “care and feeding” required to maintain a valuable investment puts the entire project at risk. We all need to remember the importance of sustainability even when we are initially excited about a new investment.

EHR systems are expensive and require tremendous resource investment, but the effort is ongoing and we need to plan accordingly.

The Key to Long Term Behavior Change
The difficulty of moving from implementing an EHR to maintaining high levels of adoption over the life of the application is strikingly similar to weight loss and weight management efforts. The percentage of overweight adults in the U.S. is staggering and continues to rise. Today, over 66 percent of adults in the United States are overweight and 59 percent of Americans are actively trying to lose weight. But the problem isn’t weight loss – it’s weight maintenance. Many of us have successfully lost weight, but can’t keep the weight off. As a matter of fact, we regain all the weight (and often more) within 3-5 years.

This isn’t a complex concept: dieting doesn’t incent long-term lifestyle change, thus we re-gain weight after we settle back into old habits. To be successful in the long-term, we need to practice weight management behaviors actively – for years, not months.

We’ve taken the dieting approach to implementing new software solutions in healthcare for too long. We prepare for a go-live event, but fall back into our comfortable old habits afterwards – resulting in work-arounds, regression to ineffective workflows, insufficient training for new users, poor communication and errors. The process of adoption requires a radically different discipline, and the real work begins at go-live.

Instead of checking the project off your to-do list after a successful implementation, you need to create a plan to sustain the changes. A sustainment plan addresses two critical areas:

It establishes how your organization will support the ongoing needs of the end users for the life of the application. This includes communication, education and maintenance of materials and resources.

It establishes how and when your organization will collect metrics to assess end user adoption and performance.

Lack of planning and execution in these two areas will lead to a slow and steady decline in end user adoption over time.

Effective sustainment plans require resources – time and money. Keep in mind that adoption is never static; it is either improving or degrading in the organization. A series of upgrades can quickly lead to decreased proficiency among end users, completely eroding the value of the application over time. Leadership must plan for the investment and fund it to achieve improved performance.

Most organizations only achieve modest adoption after a go-live event, and it takes relentless focus to achieve the levels of adoption needed to improve quality of care, patient safety and financial outcomes. Sustainment plans are most successful when they are part of the initial budgeting and planning stages for EHR.

Metrics Make the Difference
Metrics are the differentiating factor between a highly effective sustainment plan and one that is just mediocre. End user knowledge and confidence metrics serve as a barometer for their level of proficiency, providing the earliest indication of adoption. Ultimately, performance metrics are powerful indicators of whether end users are improving, maintaining or regressing in their adoption of the system. If we get an early warning that proficiency is slipping, we can react quickly to address the problem. These metrics ensure the organization is progressing toward high levels of adoption, overcoming barriers and gaining the efficiencies promised by EHR adoption. Metrics act just as the scale does in long-term weight management; they are the first indicator that we are falling back into old behaviors that are not consistent with sustainable adoption.

Metrics also keep us on track when performance does not meet expectations. Two potential scenarios in which the go-live event is successful but performance metrics fail to reach expectations help illustrate this idea. For instance, performance metrics could not be achieved because the system is not being utilized effectively. This may be due to inadequate training and therefore lower proficiency, or a problem with the actual performance by end users in the system. Measuring end user proficiency allows us to identify “pockets” of low proficiency among certain users or departments and make sure they receive the education needed. Once users are proficient, we can refocus our attention on the performance metrics.

A second scenario is less common but more difficult to diagnose. Users could be proficient, but specific performance metrics are still not meeting expectations. In this case, we need to analyze the specific metric. Are we asking the right question? Are we collecting the right data? Are we examining a very small change in a rare occurrence? There may also be a delay in achieving certain metrics, especially if the measurements are examining small changes. A normal delay can wreak havoc if we start throwing quick fixes at the problem. In this situation, staying the course and having confidence in the metrics will bring desired results.

Like sustained weight loss, EHR adoption is hard work. Commit to a sustainment plan and a measurement strategy to ensure your EHR continues to provide the long-term value that was promised at go-live.

Xerox is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training.

The following is a guest blog post by Heather Haugen, PhD, Managing Director and CEO at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
What is the most significant barrier to Electronic Health Record (EHR) adoption for clinicians? This question was the foundation of our research published in Beyond Implementation: A Prescription for Lasting EMR Adoption in 2010. The answer wasn’t surprising then and won’t surprise you now, but let’s consider how your leaders are doing in the face of enormous change in healthcare (think telemedicine, high pharmaceutical costs, rising medical costs, medical ID theft). It’s more important than ever to focus on technology adoption in today’s healthcare climate.

The one factor that formed a pattern across every organization struggling with EHR adoption was a lack of engagement by those leading the effort, and this still holds true today. For many reasons, this is a hard pill to swallow. First, it places responsibility back on the earliest champions: those who decided to fund and move the entire organization into an EHR implementation or upgrade. Second, it requires already overworked executive and clinical leaders to make adoption a daily priority. Effective leadership is an antecedent to adoption.

There is no greater barrier to the adoption of a complex IT application in an ever-changing healthcare environment than believing we can simply pile this effort on top of the other priorities and expect success. Organizations with disengaged, part-time, and/or overworked leaders at the helm of an EHR effort will struggle and may never achieve full adoption. In contrast, organizations with leaders who are fully invested in the daily march toward adoption will not only reach the early stages of adoption, but will enjoy a reinforced cycle of meaningful clinical and financial outcomes. Leadership must take five steps to succeed in moving their organization toward EHR adoption.

Develop a “stop doing” list: Establishing a new leadership agenda requires freeing up time for those leading and working on the effort. Without reprioritizing daily tasks, EHR adoption receives inadequate time and attention. Leaders currently in charge of EHR adoption need to understand what they are going to stop doing and focus on maintaining the courage to follow through on their decision.

Create a positive tone at the top of the organization: One of the most challenging aspects of leading an EHR adoption is transforming the project into a compelling and meaningful effort for everyone. When people, especially clinicians, believe in a cause, they will go to extraordinary lengths to ensure a successful outcome. Creating a common message with purpose and constancy is not easy, and sustaining the message is even more difficult. But when leaders create the right tone for the EHR adoption message, it will be powerful and help maintain momentum to create change.

Connect to clinical leadership: The key to provider adoption of EHRs is engagement. A governance system will engage clinicians through responsibilities and accountabilities and create clinician champions – the most highly-respected and well-networked clinicians. A high level of provider engagement can ameliorate or even overcome the common barriers to adoption, including resistance to abandoning the previous charting method, the investment of time required to learn the new system and the initial drop in productivity until users attain proficiency.

Empower decision-makers and reinforce their spheres of influence: Implementing or upgrading an EHR requires thoughtful consideration of the policies and procedures that will govern the use of the system. There are many stakeholders with a myriad of opinions and often competing interests that can dramatically slow adoption of the EHR. Adhering to a well-defined governance process ensures that the right people are involved at the right time with the right information. The lack of governance allows the wrong people to endlessly debate decisions, ignore standards and often conclude by making the wrong decisions. Leaders must establish strong governance processes that define expectations around adoption of the EHR, involve the right stakeholders to make decisions, establish policies and best practices and ultimately evaluate performance against expectations. Governance must also be flexible enough to evolve over time.

Relentlessly pursue meaningful clinical and financial metrics: The payoff for adopting an EHR comes in the form of clinical and financial outcomes. If results are neither tracked nor realized, the effort is truly a waste of time and money. Our expectations need to be realistic, but it really is the leaders who are accountable for the relentless pursuit of positive outcomes. Leaders must incent the right people to collect, analyze, and report on the data. Similar to engaging clinicians, this requires some finesse. The good news is that clinicians are generally interested in these metrics and may find the numbers compelling enough to change processes enough to impact the outcomes. Identify several key metrics that are easy to collect, work to improve them and then measure again.

Now is the time to create a new leadership agenda to drive EHR adoption and ultimately improve patient care – which is the goal we all share!

Xerox is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of the things that EHR salespeople and EHR vendor websites like to proclaim is that their EHR can be implemented with no change. They use adjectives like “easy” and “simple” to describe their EHR implementations. Certainly EHR salespeople are trained to say things like “will adapt to any workflow” and “our system is so configurable you can change it however you like.”

Certainly this type of message rings well with doctors who are afraid of the changes that EHR will bring. Let me assure everyone who’s reading this that EHR requires change. This is true of every EHR vendor, for every specialty, and every size organization. Change and EHR go hand in hand. What we have to get over is thinking that change is bad. Change can often be good, if it’s done right.

For those who don’t want to read the whole whitepaper, here are the four EHR change management mistakes:
1. Mismatched IT
2. Misplaced Resources
3. Missed Accountability
4. Mismanaged Logistics

The whitepaper also talks about the evolutionary role of IT in today’s medical practice. First, IT provides basic functionality. Next, IT adds some value. Finally, IT delivers significant benefit. I’ve seen this evolution first hand in many organizations. Each step of the process requires managing changes that lead to the eventual benefits. However, far too many people get stuck in the basic functionality and never make it to the significant benefits.

If I were to take one of the mistakes above to highlight why many miss out on significant benefits it would be Missed Accountability. At the core of this idea is having effective leadership. I’ve never seen an organization go through the EHR change effectively without strong leadership.

What do you or your organization do to manage the change required by EHR?

Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use,
ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!

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We never sell or give out your contact information. We respect our readers' privacy.